What’s New in Esophageal Cancer Research?

Research into the causes, prevention, and treatment of esophageal cancer is now being done at many medical centers, university hospitals, and other institutions around the world.

Genetics

Researchers have found that certain gene variants are more common in people with Barrett’s esophagus. This may lead to new tests for finding the people who are likely to get Barrett’s esophagus and esophageal cancer earlier, so that these problems can be prevented. Understanding these changes may also lead to new targeted therapies that overcome the effects of these abnormal genes.

Screening and prevention

The rate of adenocarcinoma of the esophagus has risen sharply in recent decades. Efforts are now being made to reduce obesity, a major risk factor for this form of cancer (and several other types as well).

In people with Barrett’s esophagus, researchers are trying to determine if newer tests can tell which patients are likely to go on to develop cancer. This may help doctors determine which patients need intense follow-up and which ones can be examined less frequently.

Researchers are also looking for ways to help stop Barrett’s cells from turning into pre-cancer or cancer. Drugs such as proton pump inhibitors and aspirin are now being studied for this purpose.

Treatment

Surgery

Doctors are using newer imaging tests and other tests to better determine which people are more likely to be helped by esophagectomy, and which people are less likely to benefit from this major operation.

Doctors are also constantly improving the surgery techniques used to treat esophageal cancer, aiming to make these operations safer and help patients recover from surgery more quickly.

Chemotherapy

Many studies are testing new ways to combine chemotherapy (chemo) drugs already known to be active against esophageal cancer to try to improve their effectiveness. Other studies are testing the best ways to combine chemotherapy with radiation therapy.

Researchers are also looking to see if they can examine the proteins inside esophageal cancer cells to tell whether the cancer is likely to respond to chemotherapy. This is important because many people get chemo and radiation as part of their initial treatment, often before surgery. Knowing if a person’s cancer is likely to respond to chemo might help doctors choose the best treatment option for the person.

Immunotherapy

An important part of the immune system is its ability to keep itself from attacking normal cells in the body. To do this, it uses “checkpoints” – molecules on immune cells that need to be turned on (or off) to start an immune response. Cancer cells sometimes use these checkpoints to avoid being attacked by the immune system.

Immunotherapy drugs known as checkpoint inhibitors are useful in some other cancers and are now being tested in esophageal cancer. For example, the drug pembrolizumab (Keytruda) targets PD-1, a protein on immune system T cells, that normally helps keep these cells from attacking other cells in the body. Targeting this protein can help the immune system recognize and attack cancer cells. Pembrolizumab is now approved to treat some advanced cancers of the gastroesophageal junction. It is also being studied in advanced esophageal cancer that has not responded to treatment and cannot be removed by surgery. Nivolumab (Opdivo), which also targets PD-1, and many other immunotherapy drugs are also being studied for use against esophageal cancer.